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Iliya J, Shatima DR, Tagbo BN, Ayede AI, Fagbohun AO, Rasaq A, Nalban S, Elon IW, Mohammed-Nafiu R, Ahmed P, Oyewole OB, Bakare AA, Yusuf BO, Akinrinoye OO, Ogala WN, Falade AG. Pneumonia hospitalizations and mortality in children 3 - 24-month-old in Nigeria from 2013 to 2020: Impact of pneumococcal conjugate vaccine ten valent (PHiD-CV-10). Hum Vaccin Immunother 2023; 19:2162289. [PMID: 36597576 PMCID: PMC9980440 DOI: 10.1080/21645515.2022.2162289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Pneumococcal conjugate vaccine ten valent (PCV 10) was introduced into Nigeria in three phases. Phase 3 introduction started in August 2016. However, its impact on pneumonia admissions and mortality among vaccinated Nigerian children has not been determined. Data in the period before PCV-10 introduction (3 August 2013-2 August 2016), and after (3 August 2017-2 August 2020) were retrospectively extracted from the medical charts of eligible patients aged 3-24 months with hospitalized radiological pneumonia at the University College Hospital (UCH), Ibadan; National Hospital (NH), Abuja; and Federal Teaching Hospital (FTH), Gombe, allowing for an intervening period of 1 year. Proportions of the patients with hospitalized pneumonia and case fatality rates were determined during both periods. The results were compared using z-test, multiple logistic regression analysis and p < .05 was considered significant. Adjusted pneumonia hospitalization rates between the two periods increased at the NH Abuja (10.7% vs 14.6%); decreased at the UCH, Ibadan (8.7% vs 6.9%); and decreased at the FTH, Gombe (28.5% vs 18.9%). Case fatality rates decreased across all the sites during the post-PCV introduction period: NH Abuja, from 6.6% to 4.4% (p = .106); FTH, Gombe, 11.7% to 7.7% (p = .477); and UCH, Ibadan, 2.0% to 0% (p = .045); but only significant at Ibadan. Overall, proportion of hospitalized pneumonia cases decreased after 3 years of PCV 10 introduction into the National Immunization Programme in Nigeria. The case fatality rate during post-PCV 10 introduction decreased at all the three sites, but this difference was significant at the UCH, Ibadan.
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Affiliation(s)
- Jalo Iliya
- Department of Pediatrics, Gombe State University, Gombe, Nigeria
| | - Denis R. Shatima
- Department of Pediatrics, National Hospital Abuja, Abuja, Nigeria
| | - Beckie N. Tagbo
- Department of Pediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Adejumoke I. Ayede
- Department of Pediatrics, University College Hospital, Ibadan, Nigeria,Department of Pediatrics, University of Ibadan, Ibadan, Nigeria
| | | | - Aliu Rasaq
- Department of Pediatrics, Gombe State University, Gombe, Nigeria
| | - Sarah Nalban
- Department of Pediatrics, Gombe State University, Gombe, Nigeria
| | - Isaac W. Elon
- Department of Pediatrics, Gombe State University, Gombe, Nigeria
| | | | - Patience Ahmed
- Department of Pediatrics, National Hospital Abuja, Abuja, Nigeria
| | | | - Ayobami A. Bakare
- Department of Pediatrics, University College Hospital, Ibadan, Nigeria
| | - Bidemi O. Yusuf
- Department of Epidemiology, Medical Statistics and Environmental Health, University of Ibadan, Ibadan, Nigeria
| | | | - William N. Ogala
- Department of Pediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Adegoke G. Falade
- Department of Pediatrics, University College Hospital, Ibadan, Nigeria,Department of Pediatrics, University of Ibadan, Ibadan, Nigeria,CONTACT Adegoke G. Falade Department of Paediatrics, University College Hospital, Queen Elizabeth II Road, Orita-Mefa, Ibadan, Oyo2410000, Nigeria
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Yang J, Li J, Lv R, Wang X, Zheng C, Gu Y, Zhang M. Analyzing the epidemic situation and influencing factors of childhood pneumonia during the COVID-19 epidemic period in Laiwu, China. Medicine (Baltimore) 2023; 102:e35052. [PMID: 37657011 PMCID: PMC10476834 DOI: 10.1097/md.0000000000035052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/11/2023] [Indexed: 09/03/2023] Open
Abstract
This study aimed to analyze the trends of childhood pneumonia before and after the corona virus disease 2019 (COVID-19) pandemic in Laiwu, China, and explore the associated risk factors to provide a reference for the prevention, control, and treatment of childhood pneumonia. In this cross-sectional study, data were collected from 11,716 children aged 3 to 12 years who underwent chest radiography/computed tomography from January 2018 to December 2021 in Laiwu, China. The generalized estimating equation model was used to analyze the time trend of the pneumonia detection rate. Multivariate logistic regression analysis was used to analyze the risk factors for pneumonia in children. The overall pneumonia detection rate was 40.3% (4721/11,716). The pneumonia detection rate was 41.5% and 39.5% in 2018 and 2019, respectively, before the COVID-19 pandemic, which decreased to 38.1% in 2020 during the pandemic and increased to 40.7% in 2021 after the pandemic. Multivariate logistic regression analysis showed that preterm birth (odds ratio [OR] = 1.68), frequent exposure to secondhand smoke (OR = 1.79), hospitalization ≥ 1 time in half a year (OR = 2.13), and history of allergic rhinitis (OR = 2.14) were risk factors for pneumonia in children. Wearing masks when outdoors (OR = 0.89) and engaging in regular physical activity (OR = 0.65) were protective factors. The pneumonia detection rate in children showed a decreasing trend during the COVID-19 pandemic in 2020 but an increasing trend after the pandemic in 2021. Premature birth, exposure to secondhand smoke, frequent hospitalization, and allergic rhinitis were risk factors for pneumonia in children. Wearing masks when outdoors and exercising may reduce the risk of pneumonia in children.
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Affiliation(s)
- Jimei Yang
- Jinan Second Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Junqing Li
- Jinan Second Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Ruiliang Lv
- Jinan Second Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Xiang Wang
- Jinan Second Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Chunfeng Zheng
- Jinan Second Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Yan Gu
- Jinan Second Maternal and Child Health Hospital, Jinan, Shandong, China
| | - Mingzhu Zhang
- Affiliated Hospital of Qingdao University, Jinan, Shandong, China
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Peng QY, Zhang L, Deng H, Ye YM, Huang RL, Liang YQ, Feng SS, Li J, Luo XQ, Peng YL. Poor accuracy of single serological IgM tests in children with suspected acute Mycoplasma pneumoniae infection in Guangzhou, China. J Med Microbiol 2023; 72. [PMID: 36920846 DOI: 10.1099/jmm.0.001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Introduction. Early and accurate diagnosis of Mycoplasma pneumoniae (MP) infection of children with pneumonia is at the core of treatment in clinical practice.Gap Statement. Serological immunoglobulin M (IgM) tests for MP infection of children in south China have been rarely described.Aim. To assess the diagnostic performance and clinical application of serodiagnosis of MP infection in paediatric pneumonia patients.Methodology. Serum samples from 144 children diagnosed with MP pneumonia were subjected to a particle agglutination (PA)-based IgM assay. Meanwhile, we used an established suspension array as the reference standard method for the detection of MP DNA in bronchoalveolar lavage fluid (BALF) from all patients to assess the reliability of serological assays.Results. When running immunological testing in single serum samples, 80.6 %(79/98) of cases were diagnosed with MP infection, whereas only 55 (56.1 %) cases were positive in MP DNA analysis. Furthermore, single serum tests for IgM during acute MP infection resulted in 85.5 % (47/55) sensitivity and 25.6 % (11/43) specificity. Nevertheless, immunological testing and MP DNA analysis yielded the same results when paired sera were available for MP IgM antibody testing.Conclusion. Paired serological IgM assays are necessary for the determination of an acute MP infection, whereas single serological IgM testing is unreliable. Moreover, even a short interval of two MP serological tests works well.
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Affiliation(s)
- Qiu-Ying Peng
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Liang Zhang
- Maternal and Child Health Research Institute, Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, PR China
| | - Hua Deng
- Maternal and Child Health Research Institute, Translational Medicine Center, Guangdong Women and Children Hospital, Guangzhou, 511400, PR China
| | - Yu-Ming Ye
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Rui-Lin Huang
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Yao-Qiong Liang
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Su-Shi Feng
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Juan Li
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Xue-Qun Luo
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
| | - Yan-Li Peng
- Department of Pediatrics, Guangzhou Panyu Maternal and Children Health Hospital, Guangzhou Panyu District He Xian Memorial Hospital, Guangzhou, 511499, PR China
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Chen X, Liu Q, Chen J, Liu Y. LncRNA RP11-248E9.5 and RP11-456D7.1 are Valuable for the Diagnosis of Childhood Pneumonia. Int J Gen Med 2021; 14:895-902. [PMID: 33762841 PMCID: PMC7982557 DOI: 10.2147/ijgm.s291239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/05/2021] [Indexed: 12/20/2022] Open
Abstract
Background Pneumonia is a common infection of the lung parenchyma in children, and early and accurate diagnosis of childhood pneumonia (CP) is important for implementing appropriate preventive and treatment strategies. This study aimed to evaluate the diagnostic value of the combination of long non-coding RNA (lncRNA) RP11-248E9.5, RP11-456D7.1, c-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in CP. Patients and Methods A total of 50 healthy children (HC) and 100 CP patients were enrolled. The serum expression of RP11-248e9.5 and RP11-456d7.1 was detected by qRT-PCR. The white blood cell (WBC), hemoglobin (HB), platelet (PLT), neutrophil, and lymphocyte were analyzed by automated hematology analyzer. The serum levels of CRP and procalcitonin (PCT) were analyzed by automatic biochemical analyzer. The receiver operating characteristic (ROC) curves were applied to evaluate the diagnostic value in CP. Results The NLR and PLR, expression of RP11-248E9.5 and RP11-456D7.1, and serum levels of CRP and PCT were significantly higher in the CP group than those in the HC group. Both RP11-248E9.5 (AUC, 0.86; sensitivity, 84%; specificity, 78%) and RP11-456D7.1 (AUC, 0.89; sensitivity, 79%; specificity, 92%) exhibited certain diagnostic value in CP. The diagnostic values of PCT, CRP, NLR and PLR in CP were limited by low sensitivity (≤ 71%). The combination of multiple indicators improved the diagnostic value. The combination of RP11-248E9.5, RP11-456D7.1, CRP, NLR, and PLR had the best diagnostic value in CP (AUC, 0.992; Sensitivity, 0.97; Specificity, 0.99). Conclusion The combination of RP11-248E9.5, RP11-456D7.1, CRP, NLR, and PLR was a potential diagnostic strategy for CP.
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Affiliation(s)
- Xiudong Chen
- Department of Pediatric, Zaozhuang Maternal and Child Health Care Hospital, Zaozhuang City, Shandong Province, 277100, People's Republic of China
| | - Qing Liu
- Department of Pediatric, Zaozhuang Maternal and Child Health Care Hospital, Zaozhuang City, Shandong Province, 277100, People's Republic of China
| | - Juan Chen
- Department of Pediatric, Zaozhuang Maternal and Child Health Care Hospital, Zaozhuang City, Shandong Province, 277100, People's Republic of China
| | - Yuhai Liu
- Department of Pediatric, Zaozhuang Maternal and Child Health Care Hospital, Zaozhuang City, Shandong Province, 277100, People's Republic of China
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Counihan H, Baba E, Oresanya O, Adesoro O, Hamzat Y, Marks S, Ward C, Gimba P, Qazi SA, Källander K. One-arm safety intervention study on community case management of chest indrawing pneumonia in children in Nigeria - a study protocol. Glob Health Action 2021; 13:1775368. [PMID: 32856569 PMCID: PMC7480438 DOI: 10.1080/16549716.2020.1775368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Current recommendations within integrated community case management (iCCM) programmes advise community health workers (CHWs) to refer cases of chest indrawing pneumonia to health facilities for treatment, but many children die due to delays or non-compliance with referral advice. Recent revision of World Health Organization (WHO) pneumonia guidelines and integrated management of childhood illness chart booklet recommend oral amoxicillin for treatment of lower chest indrawing (LCI) pneumonia on an outpatient basis. However, these guidelines did not recommend its use by CHWs as part of iCCM, due to insufficient evidence regarding safety. We present a protocol for a one-arm safety intervention study aimed at increasing access to treatment of pneumonia by training CHWs, locally referred to as Community Oriented Resource Persons (CORPs) in Nigeria. The primary objective was to assess if CORPs could safely and appropriately manage LCI pneumonia in 2-59 month old children, and refer children with danger signs. The primary outcomes were the proportion of children 2-59 months with LCI pneumonia who were managed appropriately by CORPs and the clinical treatment failure within 6 days of LCI pneumonia. Secondary outcomes included proportion of children with LCI followed up by CORPs on day 3; caregiver adherence to treatment for chest indrawing, acceptability and satisfaction of both CORP and caregivers on the mode of treatment, including caregiver adherence to treatment; and clinical relapse of pneumonia between day 7 to 14 among children whose signs of pneumonia disappeared by day 6. Approximately 308 children 2-59 months of age with LCI pneumonia would be needed for this safety intervention study.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Shamim Ahmad Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organisation , Geneva, Switzerland
| | - Karin Källander
- Malaria Consortium , London, UK.,Department of Public Health Sciences, Karolinska Institutet , Stockholm, Sweden
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6
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Tariku A, Okwaraji YB, Worku A, Biks GA, Åke Persson L, Berhane Y. Prevention and treatment of suspected pneumonia in Ethiopian children less than five years from household to primary care. Acta Paediatr 2021; 110:602-610. [PMID: 32478446 PMCID: PMC7891650 DOI: 10.1111/apa.15380] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
Aim Ethiopia has implemented the integrated community case management to reduce mortality in childhood diseases. We analysed prevention, care seeking and treatment of suspected pneumonia from household to health facility in Ethiopia. Methods Analyses were based on a survey in four regions that included modules covering 5714 households, 169 health posts with 276 health extension workers and 155 health centres with 175 staff. Caregivers of children aged 2‐59 months responded to questions on awareness of services and care seeking for suspected pneumonia. Pneumonia‐related knowledge of health workers was assessed. Results When a child had suspected pneumonia, 46% (95% CI: 25,68) sought care at health facilities, and 27% (95% CI: 12,51) received antibiotics. Forty‐one per cent had received full immunisation. One‐fifth (21%, 95%: 19,22) of the caregivers were aware of pneumonia treatment. Sixty‐four per cent of the health extension workers correctly mentioned fast or difficult breathing as signs of suspected pneumonia, and 88% suggested antibiotics treatment. Conclusion The caregivers' awareness of suspected pneumonia treatment and the utilisation of these services were low. Some of the health extension workers were not knowledgeable about suspected pneumonia. Strengthening primary health care, including immunisation, and enhancing the utilisation of services are critical for further reduction of pneumonia mortality.
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Affiliation(s)
- Amare Tariku
- Department of Human Nutrition Institute of Public Health College of Medicine and Health Sciences University of Gondar Gondar Ethiopia
- Addis Continental Institute of Public Health Addis Ababa Ethiopia
| | - Yemisrach B. Okwaraji
- Ethiopian Public Health Institute Addis Ababa Ethiopia
- London School of Hygiene & Tropical Medicine London UK
| | - Alemayehu Worku
- Addis Continental Institute of Public Health Addis Ababa Ethiopia
- School of Public Health Addis Ababa University Addis Ababa Ethiopia
| | - Gashaw Andargie Biks
- Department of Health System and Policy College of Medicine and Health Sciences Institute of Public Health University of Gondar Gondar Ethiopia
| | - Lars Åke Persson
- Ethiopian Public Health Institute Addis Ababa Ethiopia
- London School of Hygiene & Tropical Medicine London UK
| | - Yemane Berhane
- Addis Continental Institute of Public Health Addis Ababa Ethiopia
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Ginsburg AS, Lenahan JL, Jehan F, Bila R, Lamorte A, Hwang J, Madrid L, Nisar MI, Vitorino P, Kanth N, Balcells R, Baloch B, May S, Valente M, Varo R, Nadeem N, Bassat Q, Volpicelli G. Performance of lung ultrasound in the diagnosis of pediatric pneumonia in Mozambique and Pakistan. Pediatr Pulmonol 2021; 56:551-560. [PMID: 33205892 PMCID: PMC7898329 DOI: 10.1002/ppul.25176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/28/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Improved pneumonia diagnostics are needed in low-resource settings (LRS); lung ultrasound (LUS) is a promising diagnostic technology for pneumonia. The objective was to compare LUS versus chest radiograph (CXR), and among LUS interpreters, to compare expert versus limited training with respect to interrater reliability. METHODS We conducted a prospective, observational study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at two district hospitals in Mozambique and Pakistan, and assessed LUS and CXR examinations. The primary endpoint was interrater reliability between LUS and CXR interpreters for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. RESULTS Interrater reliability was excellent for expert LUS interpreters, but poor to moderate for expert CXR interpreters and onsite LUS interpreters with limited training. CONCLUSIONS Among children with WHO IMCI chest-indrawing pneumonia, expert interpreters may achieve substantially higher interrater reliability for LUS compared to CXR, and LUS showed potential as a preferred reference standard. For point-of-care LUS to be successfully implemented for the diagnosis and management of pneumonia in LRS, the clinical environment and amount of appropriate user training will need to be understood and addressed.
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Affiliation(s)
| | | | - Fyezah Jehan
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Rubao Bila
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | | | - Jun Hwang
- Clinical Trial CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Lola Madrid
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | | | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
| | - Neel Kanth
- Sindh Government Children's Hospital–Poverty Eradication InitiativeKarachiPakistan
| | - Reyes Balcells
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Benazir Baloch
- Department of Pediatrics and Child HealthAga Khan UniversityKarachiPakistan
| | - Susanne May
- Clinical Trial CenterUniversity of WashingtonSeattleWashingtonUSA
| | - Marta Valente
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Rosauro Varo
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
| | - Naila Nadeem
- Department of RadiologyAga Khan UniversityKarachiPakistan
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM)MaputoMozambique
- ISGlobal, Hospital Clínic, Universitat de BarcelonaBarcelonaSpain
- Institució Catalana de Recerca i Estudis Avançats (ICREA)BarcelonaSpain
- Department of Pediatrics, Hospital Sant Joan de DeuUniversitat de BarcelonaBarcelonaSpain
- Consorcio de Investigacion Biomedica en Red de Epidemiologia y Salud Publica (CIBERESP)MadridSpain
| | - Giovanni Volpicelli
- Department of Emergency MedicineSan Luigi Gonzaga University HospitalOrbassanoItaly
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Nguyen PT, Tran HT, Fitzgerald DA, Graham SM, Marais BJ. Antibiotic use in children hospitalised with pneumonia in Central Vietnam. Arch Dis Child 2020; 105:713-719. [PMID: 32079569 DOI: 10.1136/archdischild-2019-317733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/11/2019] [Accepted: 01/22/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Excessive use of antibiotics has been noted in children with respiratory tract infections in Vietnam, but antibiotic use in hospitalised children is poorly documented. Antibiotic use and direct healthcare costs in children hospitalised with pneumonia in central Vietnam were assessed. METHODS A prospective descriptive study of children under 5 years old admitted with a primary admission diagnosis of 'pneumonia' to the Da Nang Hospital for Women and Children over 1 year. RESULTS Of 2911 children hospitalised with pneumonia, 2735 (94.0%) were classified as 'non-severe' pneumonia by the admitting physician. In total, 2853 (98.0%) children received antibiotics. Intravenous antibiotics were given to 336 (12.3%) children with 'non-severe' and 157/176 (89.2%) children with 'severe' pneumonia; those with 'non-severe' pneumonia accounted for 68.2% (336/493) of intravenous antibiotics given. Only 19.3% (95/493) of children on intravenous antibiotics were stepped down to an oral antibiotic. Cefuroxime was the preferred oral agent, and ceftriaxone was the preferred injectable agent. Hospital admission for oral antibiotics in 'non-severe' pneumonia was a major cost driver, with an average direct cost of US$78.9 per patient, accounting for 54.0% of the total hospitalisation cost in the study cohort. In addition, 336 (12.3%) children with non-severe pneumonia received intravenous antibiotics without indication, accounting for a further 23.2% of hospitalisation costs. CONCLUSION Limiting unnecessary hospitalisation and considering early intravenous to oral step down antibiotic will reduce direct health system costs and morbidity in children with respiratory tract infections in Vietnam.
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Affiliation(s)
- Phuong Tk Nguyen
- Department of Respirology, Da Nang Hospital for Women and Children, Da Nang, Vietnam .,Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Hoang T Tran
- Department of Neonatology, Da Nang Hospital for Women and Children, Da Nang, Vietnam
| | - Dominic A Fitzgerald
- Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, New South Wales, Australia.,Respiratory Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Steve M Graham
- Department of Paediatrics, Centre for International Child Health, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia, Melbourne, Victoria, Australia
| | - Ben J Marais
- Discipline of Paediatrics and Adolescent Medicine, The University of Sydney, Sydney, New South Wales, Australia
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Källander K, Ward C, Smith H, Bhattarai R, KC A, Timsina D, Lamichhane B, Maurel A, Ram Shrestha P, Baral S, McWhorter C, LaBarre P, de Cola MA, Baker K. Usability and acceptability of an automated respiratory rate counter to assess childhood pneumonia in Nepal. Acta Paediatr 2020; 109:1207-1220. [PMID: 31762072 PMCID: PMC7318335 DOI: 10.1111/apa.15108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/03/2023]
Abstract
AIM Pneumonia is the leading cause of child death after the neonatal period, resulting from late care seeking and inappropriate treatment. Diagnosis involves counting respiratory rate (RR); however, RR counting remains challenging for health workers and miscounting, and misclassification of RR is common. We evaluated the usability of a new automated RR counter, the Philips Children's Respiratory Monitor (ChARM), to Female Community Health Volunteers (FCHVs), and its acceptability to FCHVs and caregivers in Nepal. METHODS A cross-sectional study was conducted in Jumla district, Nepal. About 133 FCHVs were observed between September and December 2018 when using ChARM during 517 sick child consultations, 264 after training and 253 after 2 months of routine use of ChARM. Acceptability of the ChARM was explored using semi-structured interviews. RESULTS FCHV adherence to guidelines after 2 months of using ChARM routinely was 52.8% (95% CI 46.6-58.9). The qualitative findings suggest that ChARM is acceptable to FCHVs and caregivers; however, capacity constraints such as older age and low literacy and impacted device usability were mentioned. CONCLUSION Further research on the performance, cost-effectiveness and implementation feasibility of this device is recommended, especially among low-literate CHWs.
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Affiliation(s)
- Karin Källander
- Malaria Consortium London UK
- Programme Division Health Section UNICEF New York NY USA
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
| | | | | | | | - Ashish KC
- Health & Nutrition Section UNICEF Nepal Kathmandu Nepal
- Department of Women's and Children's Health International Maternal and Child Health (IMCH) Uppsala University Uppsala Sweden
| | | | - Bikash Lamichhane
- Department of Health Services Ministry of Health & Population Kathmandu Nepal
| | | | | | | | - Cindy McWhorter
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | - Paul LaBarre
- UNICEF Supply DivisionProduct Innovation CentreCopenhagen Denmark
| | | | - Kevin Baker
- Malaria Consortium London UK
- Department of Public Health Sciences Karolinska Institutet Stockholm Sweden
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Li R, Liang P, Yuan J, He F. Exosomal miR-103a-3p ameliorates lipopolysaccharide-induced immune response in BEAS-2B cells via NF-κB pathway by targeting transducin β-like 1X related protein 1. Clin Exp Pharmacol Physiol 2020; 47:620-627. [PMID: 31876003 DOI: 10.1111/1440-1681.13241] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/15/2019] [Accepted: 12/20/2019] [Indexed: 12/30/2022]
Abstract
Abnormal immune response contributes to pathophysiology of pneumonia and is recognized as a main factor for high incidence rate in children. The association between exosomes and inflammation has been reported in diverse cell types and diseases. The current study focuses on exploring the effects of exosomal miR-103a-3p on lipopolysaccharide (LPS)-induced inflammation, and investigates the underlying mechanisms. We proved that miR-103a-3p was lowly expressed in blood samples of pneumonia patients and LPS-induced lung cells, and overexpression of miR-103a-3p weaken the LPS-induced inflammation. Using luciferase reporter assay and immunoprecipitation assay, we demonstrated that miR-103a-3p directly binds to a specific region of transducin β-like 1X related protein 1 (TBL1XR1), mediating the NF-κB signalling pathway, thus regulating immune response. Taken together, our data revealed that miR-103a-3p functions as an anti-inflammatory gene in childhood pneumonia and can be applied as therapeutic targets for the treatment of childhood pneumonia in the future.
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Affiliation(s)
- Ruina Li
- The Third Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Pengbo Liang
- Chinese and Western Medicine, Xi'an Children's Hospital, Xi'an, China
| | - Juan Yuan
- The Second Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Fangzhi He
- Outpatient of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
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11
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Ginsburg AS, Lenahan JL, Izadnegahdar R, Ansermino JM. A Systematic Review of Tools to Measure Respiratory Rate in Order to Identify Childhood Pneumonia. Am J Respir Crit Care Med 2019; 197:1116-1127. [PMID: 29474107 DOI: 10.1164/rccm.201711-2233ci] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pneumonia is the leading infectious cause of death in children worldwide, with most deaths occurring in developing countries. Measuring respiratory rate is critical to the World Health Organization's guidelines for diagnosing childhood pneumonia in low-resource settings, yet it is difficult to accurately measure. We conducted a systematic review to landscape existing respiratory rate measurement technologies. We searched PubMed, Embase, and Compendex for studies published through September 2017 assessing the accuracy of respiratory rate measurement technologies in children. We identified 16 studies: 2 describing manual devices and 14 describing automated devices. Although both studies describing manual devices took place in low-resource settings, all studies describing automated devices were conducted in well-resourced settings. Direct comparison between studies was complicated by small sample size, absence of a consistent reference standard, and variations in comparison methodology. There is an urgent need for affordable and appropriate innovations that can reliably measure a child's respiratory rate in low-resource settings. Accelerating development or scale-up of these technologies could have the potential to advance childhood pneumonia diagnosis worldwide.
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Affiliation(s)
- Amy Sarah Ginsburg
- 1 Department of Global Health, Save the Children Federation, Inc., Fairfield, Connecticut
| | - Jennifer L Lenahan
- 1 Department of Global Health, Save the Children Federation, Inc., Fairfield, Connecticut
| | - Rasa Izadnegahdar
- 2 Department of Pediatrics, University of Washington, Seattle, Washington.,3 Seattle Children's Hospital, Seattle, Washington; and
| | - J Mark Ansermino
- 4 Department of Anesthesiology, Pharmacology, and Therapeutics, The University of British Columbia, Vancouver, British Columbia, Canada
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12
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Ginsburg AS, May S, Nkwopara E, Ambler G, McCollum ED, Mvalo T, Phiri A, Lufesi N. Clinical Outcomes of Pneumonia and Other Comorbidities in Children Aged 2-59 Months in Lilongwe, Malawi: Protocol for the Prospective Observational Study "Innovative Treatments in Pneumonia". JMIR Res Protoc 2019; 8:e13377. [PMID: 31359870 PMCID: PMC6690162 DOI: 10.2196/13377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 01/29/2023] Open
Abstract
Background Pneumonia is the leading infectious cause of death worldwide among children below 5 years of age. Clinical trials are conducted to determine optimal treatment; however, these trials often exclude children with comorbidities and severe illness. Conclusions Given the paucity of data from Africa, African-based research is necessary to establish optimal management of childhood pneumonia in malaria-endemic settings in the region. An expanded evidence base that includes children with pneumonia and other comorbidities, who are at high risk for mortality or have other complications and are therefore typically excluded from childhood pneumonia clinical trials, can contribute to future iterations of the World Health Organization Integrated Management of Childhood Illness guidelines. Methods The study enrolled 1000 children with pneumonia presenting to the outpatient departments of Kamuzu Central or Bwaila District Hospitals in Lilongwe, Malawi, who were excluded from concurrent randomized controlled clinical trials investigating fast breathing and chest indrawing pneumonia and who met the inclusion criteria for this prospective observational study. Each child received standard care for their illnesses per Malawian guidelines and hospital protocol and was prospectively followed up with scheduled study visits on days 1, 2 (if hospitalized), 6, 14 (in person), and 30 (by phone). Our primary objectives are to describe the clinical outcomes of children who meet the inclusion criteria for this study and to investigate whether the percentages of children cured at day 14 among those with either fast breathing or chest indrawing pneumonia and comorbidities such as severe malaria, anemia, severe acute malnutrition, or HIV are lower than those in children without these comorbidities in the standard care groups in concurrent clinical trials. This study was approved by the Western Institutional Review Board, Malawi College of Medicine Research and Ethics Committee, and the Malawi Pharmacy, Medicines and Poisons Board. Objective This prospective observational study aimed to assess the clinical outcomes of children aged 2-59 months with both pneumonia and other comorbidities in a malaria-endemic region of Malawi. Results The Innovative Treatments in Pneumonia project was funded by the Bill and Melinda Gates Foundation (OPP1105080) in April 2014. Enrollment in this study began in 2016, and the primary results are expected in 2019. International Registered Report Identifier (IRRID) DERR1-10.2196/13377
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Affiliation(s)
| | - Susanne May
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | | | | | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, John Hopkins School of Medicine, Baltimore, MD, United States
| | - Tisungane Mvalo
- University of North Carolina Project: Lilongwe, Central Region, Lilongwe, Malawi
| | - Ajib Phiri
- Department of Paediatrics and Child Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Norman Lufesi
- Ministry of Health, Republic of Malawi, Lilongwe, Malawi
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13
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Abstract
RATIONALE Childhood brucellosis is a significant community health problem. It may imitate other conditions and may be misdiagnosed. Pulmonary involvement is a rare complication of childhood brucellosis. PATIENT CONCERNS A 23-month-old child was referred to our hospital with a 3-week history of fevers and cough. He was initially diagnosed with pneumonia. DIAGNOSES AND INTERVENTIONS Conventional antibiotic treatment was ineffectual. Total leukocyte count was 10,300/mm, hemoglobin was 8.5 g/dL, and platelet count was 250,000/mm. The erythrocyte sedimentation rate and procaicltonin were 25 mm/h and 0.12 ng/mL, respectively. Chest radiography showed pneumonic infiltrate in both lungs.The initial bacteriologic test results were negative. Ten days after admission, Brucella melitensis were isolated from the second blood culture. This child was cured with the 2-drug regimen (rifampin+trimethopicin-sulfamethoxazole) for 6 weeks. OUTCOMES The child recovered well with no occurrence of complications. The child remained asmptomatic without any signs or symptoms at a follow-up of 1 year. LESSONS Non-specific findings of pulmonary brucellosis in children often make diagnosis difficult. The second blood culture is essential. In endemic areas, children with fevers and cough should be included in the diagnosis in cases of pulmonary brucellosis.
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Affiliation(s)
- Songsong Xie
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
- The First Hospital of Shihezi University
| | - Yan Zhou
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Rongjiong Zheng
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Weize Zuo
- The First Hospital of Shihezi University
| | - Yan Zhang
- The First Hospital of Shihezi University
| | - Yuanzhi Wang
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Yuexin Zhang
- Department of Infection Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi
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14
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Sarma H, Gerth-Guyette E, Shakil SA, Alom KR, Abu-Haydar E, D’Rozario M, Tariqujjaman M, Arifeen SE, Ahmed T. Evaluating the use of job aids and user instructions to improve adherence for the treatment of childhood pneumonia using amoxicillin dispersible tablets in a low-income setting: a mixed-method study. BMJ Open 2019; 9:e024978. [PMID: 31152030 PMCID: PMC6549679 DOI: 10.1136/bmjopen-2018-024978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We conducted a study to evaluate the use of job aids and simple user instructions to improve adherence for the treatment of childhood pneumonia with amoxicillin dispersible tablet (DT). DESIGN A mixed-method study implemented in three phases between October 2015 and February 2016. SETTINGS The study was implemented in two subdistricts of Bangladesh. PARTICIPANTS Caregivers of children aged 2-59 months, health service providers and key stakeholders at national and district level. INTERVENTIONS An intervention including training and job aids and user-friendly instructions was introduced in one subdistrict while standard amoxicillin DT packaging and instructions with no training served as the control in the comparison subdistrict. PRIMARY OUTCOME Adherence behaviour of caregivers of children aged 2-59 months for the treatment of childhood pneumonia with amoxicillin DT. METHODS We conducted a survey with 56 caregivers in the intervention subdistrict and 38 caregivers in the comparison subdistrict. We also conducted 44 in-depth interviews to evaluate the job aids and user-friendly instructions with healthcare providers and caregivers to assess the feasibility, usability and acceptability of the tools in intervention subdistrict. RESULTS For 5-day treatment course, 32.1% (95% CI 23.1% to 41.1%) of caregivers in the intervention subdistrict and 2.6% (95% CI 0.3% to 7.8%) in the comparison subdistrict maintained full adherence to the amoxicillin DT treatment for pneumonia. More children under 12 months were given age-appropriate treatment than older children. Key stakeholders and healthcare providers considered the use and integration of the tools into the health system to be feasible and acceptable. CONCLUSIONS The provision of tools for the treatment of childhood pneumonia with amoxicillin DT had a positive influence on adherence behaviours. These tools can help close information gaps and overcome the barriers posed by medical illiteracy and remembering instructions from providers.
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Affiliation(s)
- Haribondhu Sarma
- Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Syaket Ahmed Shakil
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | - Methelda D’Rozario
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Shams E Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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15
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Dembele BPP, Kamigaki T, Dapat C, Tamaki R, Saito M, Saito M, Okamoto M, Igoy MAU, Mercado ES, Mondoy M, Tallo VL, Lupisan SP, Egawa S, Oshitani H. Aetiology and risks factors associated with the fatal outcomes of childhood pneumonia among hospitalised children in the Philippines from 2008 to 2016: a case series study. BMJ Open 2019; 9:e026895. [PMID: 30928958 PMCID: PMC6475207 DOI: 10.1136/bmjopen-2018-026895] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Pneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children. DESIGN A 9-year case series study. SETTING Two secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines. PARTICIPANTS 5054 children aged <5 years hospitalised with severe pneumonia. METHODS Nasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death. RESULTS Of the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2-59 months, the risk factors significantly associated with death included age of 2-5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph.Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months. CONCLUSION Malnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death.
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Affiliation(s)
| | - Taro Kamigaki
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Clyde Dapat
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Raita Tamaki
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mariko Saito
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mayuko Saito
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Michiko Okamoto
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mary Ann U Igoy
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | | | - Melisa Mondoy
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Veronica L Tallo
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Socorro P Lupisan
- Research Institute for Tropical Medicine, Muntinlupa City, Philippines
| | - Shinichi Egawa
- Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| | - Hitoshi Oshitani
- Virology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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16
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Tang C, Sun H, Xiong Y, Yang J, Vitale C, Ruan L, Ai A, Yu G, Ma J, Bates D. Medication Use for Childhood Pneumonia at a Children's Hospital in Shanghai, China: Analysis of Pattern Mining Algorithms. JMIR Med Inform 2019; 7:e12577. [PMID: 30900998 PMCID: PMC6450478 DOI: 10.2196/12577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/11/2018] [Accepted: 11/20/2018] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pattern mining utilizes multiple algorithms to explore objective and sometimes unexpected patterns in real-world data. This technique could be applied to electronic medical record data mining; however, it first requires a careful clinical assessment and validation. OBJECTIVE The aim of this study was to examine the use of pattern mining techniques on a large clinical dataset to detect treatment and medication use patterns for childhood pneumonia. METHODS We applied 3 pattern mining algorithms to 680,138 medication administration records from 30,512 childhood inpatients with diagnosis of pneumonia during a 6-year period at a children's hospital in China. Patients' ages ranged from 0 to 17 years, where 37.53% (11,453/30,512) were 0 to 3 months old, 86.55% (26,408/30,512) were under 5 years, 60.37% (18,419/30,512) were male, and 60.10% (18,338/30,512) had a hospital stay of 9 to 15 days. We used the FP-Growth, PrefixSpan, and USpan pattern mining algorithms. The first 2 are more traditional methods of pattern mining and mine a complete set of frequent medication use patterns. PrefixSpan also incorporates an administration sequence. The newer USpan method considers medication utility, defined by the dose, frequency, and timing of use of the 652 individual medications in the dataset. Together, these 3 methods identified the top 10 patterns from 6 age groups, forming a total of 180 distinct medication combinations. These medications encompassed the top 40 (73.66%, 500,982/680,138) most frequently used medications. These patterns were then evaluated by subject matter experts to summarize 5 medication use and 2 treatment patterns. RESULTS We identified 5 medication use patterns: (1) antiasthmatics and expectorants and corticosteroids, (2) antibiotics and (antiasthmatics or expectorants or corticosteroids), (3) third-generation cephalosporin antibiotics with (or followed by) traditional antibiotics, (4) antibiotics and (medications for enteritis or skin diseases), and (5) (antiasthmatics or expectorants or corticosteroids) and (medications for enteritis or skin diseases). We also identified 2 frequent treatment patterns: (1) 42.89% (291,701/680,138) of specific medication administration records were of intravenous therapy with antibiotics, diluents, and nutritional supplements and (2) 11.53% (78,390/680,138) were of various combinations of inhalation of antiasthmatics, expectorants, or corticosteroids. Fleiss kappa for the subject experts' evaluation was 0.693, indicating moderate agreement. CONCLUSIONS Utilizing a pattern mining approach, we summarized 5 medication use patterns and 2 treatment patterns. These warrant further investigation.
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Affiliation(s)
- Chunlei Tang
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Huajun Sun
- Children's Hospital of Shanghai, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yun Xiong
- Shanghai Key Laboratory of Data Science, School of Computer Science, Fudan University, Shanghai, China
| | - Jiahong Yang
- Shanghai Shenkang Hospital Development Center, Shanghai, China
| | - Christopher Vitale
- Clinical Informatics for the Integrated Health Model Initiative, American Medical Association, Chicago, IA, United States
| | - Lu Ruan
- Shanghai Key Laboratory of Data Science, School of Computer Science, Fudan University, Shanghai, China
| | - Angela Ai
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Guangjun Yu
- Children's Hospital of Shanghai, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing Ma
- Department of Population Medicine, Harvard Medical School, Boston, MA, United States
| | - David Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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17
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Chiu CY, Cheng ML, Wong KS, Lai SH, Chiang MH, Tsai MH, Lin G. Metabolomics Reveals Anaerobic Bacterial Fermentation and Hypoxanthine Accumulation for Fibrinous Pleural Effusions in Children with Pneumonia. J Proteome Res 2019; 18:1248-1254. [PMID: 30757903 DOI: 10.1021/acs.jproteome.8b00864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fibrin formation in infectious parapneumonic effusion (IPE) characterizes complicated parapneumonic effusion and is important for providing guidelines for the management of IPEs that require aggressive interventions. We aim to identify metabolic mechanisms associated with bacterial invasion, inflammatory cytokines, and biochemical markers in cases of fibrinous infectious pleural effusions in children with pneumonia. Pleural fluid metabolites were determined by 1H nuclear magnetic resonance spectroscopy. Metabolites that contributed to the separation between fibrinous and nonfibrinous IPEs were identified using supervised partial least squares discriminant analysis ( Q2/ R2 = 0.84; Ppermutation < 0.01). IL-1β in the inflammatory cytokines and glucose in the biochemical markers were significantly correlated with 11 and 9 pleural fluid metabolites, respectively, and exhibited significant overlaps. Four metabolites, including glucose, lactic acid, 3-hydroxybutyric acid, and hypoxanthine, were significantly correlated with plasminogen activator inhibitor type 1 in the fibrinolytic system enzymes. Metabolic pathway analysis revealed that anaerobic bacterial fermentation with increased lactic acid and butyric acid via glucose consumption and adenosine triphosphate hydrolysis with increased hypoxanthine appeared to be associated with fibrinous IPE. Our results demonstrate that an increase in lactic acid anaerobic fermentation and hypoxanthine accumulation under hypoxic conditions are associated with fibrin formation in IPE, representing advanced pleural inflammatory progress in children with pneumonia.
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Affiliation(s)
- Chih-Yung Chiu
- Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Mei-Ling Cheng
- Department of Medical Biotechnology and Laboratory Science and Healthy Aging Research Center , Chang Gung University , Taoyuan 333 , Taiwan
| | - Kin-Sun Wong
- Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Shen-Hao Lai
- Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Meng-Han Chiang
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, and Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Imaging Core Laboratory, Institute for Radiological Research, and Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, College of Medicine , Chang Gung University , Taoyuan 333 , Taiwan
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18
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Baker K, Akasiima M, Wharton-Smith A, Habte T, Matata L, Nanyumba D, Okwir M, Sebsibe A, Marasciulo M, Petzold M, Källander K. Performance, Acceptability, and Usability of Respiratory Rate Timers and Pulse Oximeters When Used by Frontline Health Workers to Detect Symptoms of Pneumonia in Sub-Saharan Africa and Southeast Asia: Protocol for a Two-Phase, Multisite, Mixed-Methods Trial. JMIR Res Protoc 2018; 7:e10191. [PMID: 30361195 PMCID: PMC6231813 DOI: 10.2196/10191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/27/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
Background Pneumonia is one of the leading causes of death in children aged under 5 years in both sub-Saharan Africa and Southeast Asia. The current diagnostic criterion for pneumonia is based on the increased respiratory rate (RR) in children with cough or difficulty breathing. Low oxygen saturation, measured using pulse oximeters, is indicative of severe pneumonia. Health workers often find it difficult to accurately count the number of breaths, and the current RR counting devices are often difficult to use or unavailable. Nonetheless, improved counting devices and low-cost pulse oximeters are now available on the market. Objective The objective of our study was to identify the most accurate, usable, and acceptable devices for the diagnosis of pneumonia symptoms by community health workers and first-level health facility workers or frontline health workers in resource-poor settings. Methods This was a multicenter, prospective, two-stage, observational study to assess the performance and usability or acceptability of 9 potential diagnostic devices when used to detect symptoms of pneumonia in the hands of frontline health workers. Notably, 188 possible devices were ranked and scored, tested for suitability in a laboratory, and 5 pulse oximeters and 4 RR timers were evaluated for usability and performance by frontline health workers in hospital, health facility, and community settings. The performance was evaluated against 2 references over 3 months in Cambodia, Ethiopia, South Sudan, and Uganda. Furthermore, acceptability and usability was subsequently evaluated using both qualitative and quantitative methodologies in routine practice, over 3 months, in the 4 countries. Results This project was funded in 2014, and data collection has been completed. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2018. Conclusions This is the first large-scale evaluation of tools to detect symptoms of pneumonia at the community level. In addition, selecting an appropriate reference standard against which the devices were measured was challenging given the lack of existing standards and differences of opinions among experts. The findings from this study will help create a standardized and validated protocol for future studies and support further comparative testing of diagnostic devices in these settings. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12615000348550; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367306&isReview=true (Archived by Website at http://www.webcitation.org/72OcvgBcf) International Registered Report Identifier (IRRID) RR1-10.2196/10191
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Affiliation(s)
- Kevin Baker
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Malaria Consortium, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | - Karin Källander
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.,Malaria Consortium, London, United Kingdom
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19
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Li B, Zheng J, Zhang X, Hong S. Probiotic Lactobacillus casei Shirota improves efficacy of amoxicillin-sulbactam against childhood fast breathing pneumonia in a randomized placebo-controlled double blind clinical study. J Clin Biochem Nutr 2018; 63:233-237. [PMID: 30487675 PMCID: PMC6252301 DOI: 10.3164/jcbn.17-117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 12/19/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study was to investigate the efficacy of oral administration of probiotic Lactobacillus casei Shirota and amoxicillin-sulbactam in treating childhood fast breathing pneumonia. 518 children diagnosed of fast breathing pneumonia were enrolled and randomly assigned to be administered either amoxicillin-sulbactam + Lactobacillus casei Shirota or amoxicillin-sulbactam + placebo. Primary outcome was defined as treatment failure before day 3, and secondary outcome was defined as treatment failure during follow-ups on day 6 and 12. Serum levels of tumor necrosis factor-α and interferon-γ were also examined at the end of day 3. Treatment failure rate before day 3 was significantly reduced in amoxicillin-sulbactam + Lactobacillus casei Shirota group compared to amoxicillin-sulbactam + placebo group. Serum levels of tumor necrosis factor-α and interferon-γ were both significantly reduced in amoxicillin-sulbactam + placebo group on day 3. On day 6 and 12, although treatment failure rates were higher than on day 3 in both groups, it was still significantly reduced in amoxicillin-sulbactam + Lactobacillus casei Shirota group. No severe adverse effects were observed in either treatment group. In conclusion, Probiotic Lactobacillus casei Shirota, in combination with amoxicillin-sulbactam, is more effective in treating childhood fast breathing pneumonia, which supports the potential clinical application of Lactobacillus casei Shirota as a safe supplement to amoxicillin-sulbactam therapy against childhood fast breathing pneumonia.
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Affiliation(s)
- Bing Li
- Department of Pediatrics, Jinan Maternity and Child Care Hospital, No.2 Jianguoxiaojingsan Road, Jinan City 250001, Shandong, China
| | - Junqing Zheng
- Department of Pediatrics, Jinan Maternity and Child Care Hospital, No.2 Jianguoxiaojingsan Road, Jinan City 250001, Shandong, China
| | - Xia Zhang
- Clinical Laboratory, Jinan Maternity and Child Care Hospital, No.2 Jianguoxiaojingsan Road, Jinan City 250001, Shandong, China
| | - Shan Hong
- Department of Pediatrics, The Fifth Hospital of Xiamen, No.101 Min'An Road, Xiang'An District, Xiamen City 361101, Fujian, China
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Shah R, Jenda G, Lwesha V, Nsona H, Dadlani P, Swedberg E. An integrated diagnostic device for neonatal sepsis and childhood pneumonia. J Public Health Afr 2018; 9:780. [PMID: 30079170 PMCID: PMC6057719 DOI: 10.4081/jphia.2018.780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/01/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Rashed Shah
- Child Health, Save the Children, Washington DC, USA
| | | | | | | | - Pavan Dadlani
- Philips Research, High Tech Campus, Eindhoven, the Netherlands
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Hayden LP, Hardin ME, Qiu W, Lynch DA, Strand MJ, van Beek EJ, Crapo JD, Silverman EK, Hersh CP. Asthma Is a Risk Factor for Respiratory Exacerbations Without Increased Rate of Lung Function Decline: Five-Year Follow-up in Adult Smokers From the COPDGene Study. Chest 2017; 153:368-377. [PMID: 29248621 DOI: 10.1016/j.chest.2017.11.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/19/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous investigations in adult smokers from the COPDGene Study have shown that early-life respiratory disease is associated with reduced lung function, COPD, and airway thickening. Using 5-year follow-up data, we assessed disease progression in subjects who had experienced early-life respiratory disease. We hypothesized that there are alternative pathways to reaching reduced FEV1 and that subjects who had childhood pneumonia, childhood asthma, or asthma-COPD overlap (ACO) would have less lung function decline than subjects without these conditions. METHODS Subjects returning for 5-year follow-up were assessed. Childhood pneumonia was defined by self-reported pneumonia at < 16 years. Childhood asthma was defined as self-reported asthma diagnosed by a health professional at < 16 years. ACO was defined as subjects with COPD who self-reported asthma diagnosed by a health-professional at ≤ 40 years. Smokers with and those without these early-life respiratory diseases were compared on measures of disease progression. RESULTS Follow-up data from 4,915 subjects were examined, including 407 subjects who had childhood pneumonia, 323 subjects who had childhood asthma, and 242 subjects with ACO. History of childhood asthma or ACO was associated with an increased exacerbation frequency (childhood asthma, P < .001; ACO, P = .006) and odds of severe exacerbations (childhood asthma, OR, 1.41; ACO, OR, 1.42). History of childhood pneumonia was associated with increased exacerbations in subjects with COPD (absolute difference [β], 0.17; P = .04). None of these early-life respiratory diseases were associated with an increased rate of lung function decline or progression on CT scans. CONCLUSIONS Subjects who had early-life asthma are at increased risk of developing COPD and of having more active disease with more frequent and severe respiratory exacerbations without an increased rate of lung function decline over a 5-year period. TRIAL REGISTRY ClinicalTrials.gov; No. NCT00608764; https://clinicaltrials.gov.
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Affiliation(s)
- Lystra P Hayden
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Megan E Hardin
- Clinical Discovery Unit, Early Clinical Discovery, AstraZeneca, Waltham, MA
| | - Weiliang Qiu
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Matthew J Strand
- Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO
| | - Edwin J van Beek
- Department of Radiology, University of Edinburgh, Edinburgh, Scotland
| | - James D Crapo
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
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Song Z, Gu FF, Guo XK, Ni YX, He P, Han LZ. Antimicrobial Resistance and Molecular Characterization of Staphylococcus aureus Causing Childhood Pneumonia in Shanghai. Front Microbiol 2017; 8:455. [PMID: 28377752 PMCID: PMC5360135 DOI: 10.3389/fmicb.2017.00455] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/06/2017] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen causing pneumonia among children. To estimate the prevalence and molecular properties of S. aureus in children pneumonia in Shanghai, China, 107 hospitalized children with S. aureus pneumonia from two children's hospitals from January 2014 through June 2015 were studied. S. aureus isolates from the respiratory specimens were characterized by antimicrobial susceptibility, agr typing, toxin genes, multilocus sequence typing (MLST), spa, and SCCmec typing. Fifty-eight (54.2%, 58/107) were MSSA (methicillin-susceptible Staphylococcus aureus) and 49 (45.8%, 49/107) were MRSA. No isolates were found resistant to teicoplanin, sulfamethoxazole/trimethoprim, rifampicin, quinupristin/dalfopristin, linezolid, or vancomycin. However, these isolates showed high resistant rates to erythromycin, fosfomycin-trometamol and clindamycin. The agrI (87/107, 81.3%) was the most common agr allele, followed by agrIII(10/107, 9.3%), agrII(9/107, 8.4%), and agrIV(1/107, 0.9%). Six pvl-positive isolates (3 MRSA and 3 MSSA) and 7 isolates of livestock associated clone ST398 (4 MRSA, 3 MSSA) were identified. CC59 was found in 35 isolates (33 MRSA and 2 MSSA), constituting majority of MRSA (33/49, 67.35%). The dominant CC were CC59 (32.7%), CC188 (13.1%), CC7 (12.1%) and CC398 (9.3%) while t172 (16.8%), t189 (12.1%), t437 (9.3%), and t091 (9.3%) were the most common spa types. In conclusion, more particular concern should appeal to ST59-SCCmecIV-t172/t437 as it is the most common epidemic clone causing pneumonia among children in Shanghai.
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Affiliation(s)
- Zhen Song
- Faculty of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Fei-Fei Gu
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Xiao-Kui Guo
- Department of Immunology and Microbiology, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Yu-Xing Ni
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Ping He
- Department of Immunology and Microbiology, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Li-Zhong Han
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
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Minz A, Agarwal M, Singh JV, Singh VK. Care seeking for childhood pneumonia by rural and poor urban communities in Lucknow: A community-based cross-sectional study. J Family Med Prim Care 2017; 6:211-217. [PMID: 29302520 PMCID: PMC5749059 DOI: 10.4103/2249-4863.219987] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia. Aims The aim of the study was to understand the caregiver's care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow. Settings and Design Rural areas and urban slums of Lucknow district, from September 2014 to August 2015. Subjects and Methods A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (<5 years of age) were interviewed through pretested, semi-structured interview schedule. Information was gathered on episode of cough, difficult breathing, and or chest indrawing in child within 2 weeks preceding the survey, and caregiver's treatment seeking practices. Results Out of total 1065 children, 52 (%) had pneumonia within 2 weeks preceding the survey. At the onset of illness, difficult/fast breathing was identified by 86.5% caregivers, but majority of them did not perceive it as a serious condition and resort to home remedies. Only 9.6% sought appropriate care at onset of illness. Appearance of chest indrawing in the child was identified by caregivers as a serious condition and sought treatment from outside. The mean time taken from onset of illness to the seeking care from health facility was around 2½ days (2.39 ± 0.75). Qualified private practitioners (70.5%) were the preferred choice and majority (87.0%) of the children received antibiotic for pneumonia. However, even after perception of seriousness of the illness, 26.8% and 11.1% caregivers in urban slums and rural areas, respectively sought inappropriate care at the first consultation. Conclusions Caregivers were unable to perceive the severity of fast breathing leading to the delayed initiation of the appropriate treatment. There is a need of community mobilization through behavior change communication interventions to promote early symptom recognition and appropriate care seeking for pneumonia.
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Affiliation(s)
- Anurag Minz
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Monika Agarwal
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - J V Singh
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - V K Singh
- Department of Community Medicine and Public Health, King George's Medical University, Lucknow, Uttar Pradesh, India
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Naydenova E, Tsanas A, Howie S, Casals-Pascual C, De Vos M. The power of data mining in diagnosis of childhood pneumonia. J R Soc Interface 2016; 13:20160266. [PMID: 27466436 PMCID: PMC4971218 DOI: 10.1098/rsif.2016.0266] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/05/2016] [Indexed: 11/12/2022] Open
Abstract
Childhood pneumonia is the leading cause of death of children under the age of 5 years globally. Diagnostic information on the presence of infection, severity and aetiology (bacterial versus viral) is crucial for appropriate treatment. However, the derivation of such information requires advanced equipment (such as X-rays) and clinical expertise to correctly assess observational clinical signs (such as chest indrawing); both of these are often unavailable in resource-constrained settings. In this study, these challenges were addressed through the development of a suite of data mining tools, facilitating automated diagnosis through quantifiable features. Findings were validated on a large dataset comprising 780 children diagnosed with pneumonia and 801 age-matched healthy controls. Pneumonia was identified via four quantifiable vital signs (98.2% sensitivity and 97.6% specificity). Moreover, it was shown that severity can be determined through a combination of three vital signs and two lung sounds (72.4% sensitivity and 82.2% specificity); addition of a conventional biomarker (C-reactive protein) further improved severity predictions (89.1% sensitivity and 81.3% specificity). Finally, we demonstrated that aetiology can be determined using three vital signs and a newly proposed biomarker (lipocalin-2) (81.8% sensitivity and 90.6% specificity). These results suggest that a suite of carefully designed machine learning tools can be used to support multi-faceted diagnosis of childhood pneumonia in resource-constrained settings, compensating for the shortage of expensive equipment and highly trained clinicians.
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Affiliation(s)
- Elina Naydenova
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Athanasios Tsanas
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Stephen Howie
- Child Survival Theme, Medical Research Council Unit, Serrekunda, The Gambia
| | - Climent Casals-Pascual
- Nuffield Department of Medicine, Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Maarten De Vos
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
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Huque R, Ahmed F, King R, Walley J, Hicks JP, Elsey H, Nasreen S, Kumar A, Newell JN. Improving the quality of care of children in community clinics: an intervention and evaluation in Bangladesh. Public Health Action 2016; 6:77-82. [PMID: 27358800 DOI: 10.5588/pha.16.0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/14/2016] [Indexed: 11/10/2022] Open
Abstract
SETTING Community health care providers (CHCPs) in 40 rural community clinics of Comilla district, Bangladesh, were trained using a newly developed case-management job aid based on the World Health Organization Integrated Management of Childhood Illness and a communication guide. OBJECTIVES To assess 1) the change in knowledge of the CHCPs after training; 2) the absolute quality of care provided by the CHCPs (determined as the proportion of children aged <5 years [under-fives] correctly diagnosed, treated and referred); and 3) the consultation behaviour of the CHCPs. DESIGN Change in knowledge was assessed by tests pre-and post-training. The quality of care was determined by reassessments at the clinic exit by a medical officer, without a baseline comparison. Consultation behaviour was assessed through direct observation. The study was performed during 2014-2015. RESULTS The mean standard knowledge score of the CH-CPs increased from 19 to 25 (P < 0.001). Of 1490 under-fives examined, 91% were correctly diagnosed, 86% were correctly treated and 99.5% received a correct referral decision. The CHCPs performed well on most of the measures of good communication, although one third did not explain the diagnosis and treatment to patients. CONCLUSION The training was effective in changing knowledge. The CHCPs applied the knowledge gained and provided good quality care. Following these results, the Bangladesh Ministry of Health and Family Welfare has scaled up the training nationwide. The lessons learnt should be useful for other countries.
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Affiliation(s)
- R Huque
- ARK Foundation, Dhaka, Bangladesh ; Department of Economics, University of Dhaka, Dhaka, Bangladesh
| | - F Ahmed
- ARK Foundation, Dhaka, Bangladesh
| | - R King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - J Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - J P Hicks
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - H Elsey
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | | | - A Kumar
- International Union Against Tuberculosis and Lung Disease South-East Asia Office, New Delhi, India
| | - J N Newell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
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Kelly MS, Crotty EJ, Rattan MS, Wirth KE, Steenhoff AP, Cunningham CK, Arscott-Mills T, Boiditswe S, Chimfwembe D, David T, Finalle R, Feemster KA, Shah SS. Chest Radiographic Findings and Outcomes of Pneumonia Among Children in Botswana. Pediatr Infect Dis J 2016; 35:257-62. [PMID: 26569190 DOI: 10.1097/INF.0000000000000990] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chest radiography is increasingly used to diagnose pneumonia in low-income and middle-income countries. Few studies examined whether chest radiographic findings predict outcomes of children with clinically suspected pneumonia in these settings. METHODS This is a hospital-based, prospective cohort study of children 1-23 months of age meeting clinical criteria for pneumonia in Botswana. Chest radiographs were reviewed by 2 pediatric radiologists to generate a consensus interpretation using standardized World Health Organization criteria. We assessed whether final chest radiograph classification was associated with our primary outcome, treatment failure at 48 hours, and secondary outcomes. RESULTS From April 2012 to November 2014, we enrolled 249 children with evaluable chest radiographs. Median age was 6.1 months, and 58% were male. Chest radiograph classifications were primary endpoint pneumonia (35%), other infiltrate/abnormality (42%) or no significant pathology (22%). The prevalence of endpoint consolidation was higher in children with HIV infection (P = 0.0005), whereas endpoint pleural effusions were more frequent among children with moderate or severe malnutrition (P = 0.0003). Ninety-one (37%) children failed treatment, and 12 (4.8%) children died. Primary endpoint pneumonia was associated with an increased risk of treatment failure at 48 hours (P = 0.002), a requirement for more days of respiratory support (P = 0.002) and a longer length of stay (P = 0.0003) compared with no significant pathology. Primary endpoint pneumonia also predicted a higher risk of treatment failure than other infiltrate/abnormality (P = 0.004). CONCLUSIONS Chest radiograph provides useful prognostic information for children meeting clinical criteria for pneumonia in Botswana. These findings highlight the potential benefit of expanded global access to diagnostic radiology services.
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Thomas DSK, Anthamatten P, Root ED, Lucero M, Nohynek H, Tallo V, Williams GM, Simões EAF. Disease mapping for informing targeted health interventions: childhood pneumonia in Bohol, Philippines. Trop Med Int Health 2015; 20:1525-1533. [PMID: 26104587 DOI: 10.1111/tmi.12561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute lower respiratory tract infections (ALRI) are the leading cause of childhood mortality worldwide. Currently, most developing countries assign resources at a district level, and yet District Medical Officers have few tools for directing targeted interventions to high mortality or morbidity areas. Mapping of ALRI at the local level can guide more efficient allocation of resources, coordination of efforts and targeted interventions, which are particularly relevant for health management in resource-scarce settings. METHODS An efficacy study of 11-valent pneumococcal vaccine was conducted in six municipalities in the Bohol Province of central Philippines from July 2000 to December 2004. Geocoded under-five pneumonia cases (using WHO classifications) were mapped to create spatial patterns of pneumonia at the local health unit (barangay) level. RESULTS There were 2951 children with WHO-defined clinical pneumonia, of whom 1074 were severe or very severely ill, 278 were radiographic, and 219 were hypoxaemic. While most children with pneumonia were from urban barangays, there was a disproportionately higher distribution of severe/very severe pneumonia in rural barangays and the most severe hypoxaemic children were concentrated in the northern barangays most distant from the regional hospital. CONCLUSIONS Mapping of ALRI at the local administrative health level can be performed relatively simply. If these principles are applied to routinely collected IMCI classification of disease at the district level in developing countries, such efforts can form the basis for directing public health and healthcare delivery efforts in a targeted manner.
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Affiliation(s)
- Deborah S K Thomas
- Department of Geography & Environmental Sciences, University of Colorado, Denver, CO, USA
| | - Peter Anthamatten
- Department of Geography & Environmental Sciences, University of Colorado, Denver, CO, USA
| | - Elisabeth Dowling Root
- Department of Geography and Institute of Behavioral Sciences, University of Colorado, Boulder, CO, USA
| | - Marilla Lucero
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | - Hanna Nohynek
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Veronica Tallo
- Research Institute for Tropical Medicine, Metro Manila, Philippines
| | - Gail M Williams
- School of Population Health, University of Queensland, Brisbane, Qld, Australia
| | - Eric A F Simões
- Department of Pediatrics, Section of Infectious Diseases, University of Colorado, School of Medicine, Aurora, CO, USA.,Department of Epidemiology and Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
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Agweyu A, Gathara D, Oliwa J, Muinga N, Edwards T, Allen E, Maleche-Obimbo E, English M. Oral amoxicillin versus benzyl penicillin for severe pneumonia among kenyan children: a pragmatic randomized controlled noninferiority trial. Clin Infect Dis 2014; 60:1216-24. [PMID: 25550349 PMCID: PMC4370168 DOI: 10.1093/cid/ciu1166] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Evidence demonstrating noninferiority of oral amoxicillin vs benzyl penicillin for severe childhood pneumonia is largely drawn from Asian populations where mortality is low. This study confirms noninferiority and is expected to inform policy on treatment of pneumonia in sub-Saharan Africa. Background. There are concerns that the evidence from studies showing noninferiority of oral amoxicillin to benzyl penicillin for severe pneumonia may not be generalizable to high-mortality settings. Methods. An open-label, multicenter, randomized controlled noninferiority trial was conducted at 6 Kenyan hospitals. Eligible children aged 2–59 months were randomized to receive amoxicillin or benzyl penicillin and followed up for the primary outcome of treatment failure at 48 hours. A noninferiority margin of risk difference between amoxicillin and benzyl penicillin groups was prespecified at 7%. Results. We recruited 527 children, including 302 (57.3%) with comorbidity. Treatment failure was observed in 20 of 260 (7.7%) and 21 of 261 (8.0%) of patients in the amoxicillin and benzyl penicillin arms, respectively (risk difference, −0.3% [95% confidence interval, −5.0% to 4.3%]) in per-protocol analyses. These findings were supported by the results of intention-to-treat analyses. Treatment failure by day 5 postenrollment was 11.4% and 11.0% and rising to 13.5% and 16.8% by day 14 in the amoxicillin vs benzyl penicillin groups, respectively. The most frequent cause of cumulative treatment failure at day 14 was clinical deterioration within 48 hours of enrollment (33/59 [55.9%]). Four patients died (overall mortality 0.8%) during the study, 3 of whom were allocated to the benzyl penicillin group. The presence of wheeze was independently associated with less frequent treatment failure. Conclusions. Our findings confirm noninferiority of amoxicillin to benzyl penicillin, provide estimates of risk of treatment failure in Kenya, and offer important additional evidence for policy making in sub-Saharan Africa. Clinical Trial Registration. NCT01399723.
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Affiliation(s)
- Ambrose Agweyu
- Health Services Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi
| | - David Gathara
- Health Services Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi
| | - Jacquie Oliwa
- Health Services Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi
| | - Naomi Muinga
- Health Services Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi
| | - Tansy Edwards
- Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, United Kingdom
| | | | - Mike English
- Health Services Unit, Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme, Nairobi Nuffield Department of Medicine, University of Oxford, United Kingdom
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Shibata T, Wilson JL, Watson LM, LeDuc A, Meng C, Ansariadi, La Ane R, Manyullei S, Maidin A. Childhood acute respiratory infections and household environment in an Eastern Indonesian urban setting. Int J Environ Res Public Health 2014; 11:12190-203. [PMID: 25429685 PMCID: PMC4276609 DOI: 10.3390/ijerph111212190] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/05/2014] [Accepted: 11/18/2014] [Indexed: 11/30/2022]
Abstract
This pilot study evaluated the potential effect of household environmental factors such as income, maternal characteristics, and indoor air pollution on children's respiratory status in an Eastern Indonesian community. Household data were collected from cross-sectional (n = 461 participants) and preliminary childhood case-control surveys (pneumonia cases = 31 diagnosed within three months at a local health clinic; controls = 30). Particulate matter (PM2.5 and PM10) was measured in living rooms, kitchens, children's bedrooms, and outside areas in close proximity once during the case-control household interviews (55 homes) and once per hour from 6 a.m. to midnight in 11 homes. The household survey showed that children were 1.98 times (p = 0.02) more likely to have coughing symptoms indicating respiratory infection, if mothers were not the primary caregivers. More children exhibited coughing if they were not exclusively breastfed (OR = 2.18; p = 0.06) or there was a possibility that their mothers were exposed to environmental tobacco smoke during pregnancy (OR = 2.05; p = 0.08). This study suggests that household incomes and mother's education have an indirect effect on childhood pneumonia and respiratory illness. The concentrations of PM2.5 and PM10 ranged from 0.5 to 35.7 µg/m3 and 7.7 to 575.7 µg/m3, respectively, based on grab samples. PM was significantly different between the case and control groups (p < 0.01). The study also suggests that ambient air may dilute indoor pollution, but also introduces pollution into the home from the community environment. Effective intervention programs need to be developed that consider multiple direct and indirect risk factors to protect children.
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Affiliation(s)
- Tomoyuki Shibata
- Public Health Program, Northern Illinois University, DeKalb, IL 60115, USA.
| | - James L Wilson
- Institute of the Study for Environment, Sustainability, and Energy, Northern Illinois University, DeKalb, IL 60115, USA.
| | - Lindsey M Watson
- Public Health Program, Northern Illinois University, DeKalb, IL 60115, USA.
| | - Alyse LeDuc
- Public Health Program, Northern Illinois University, DeKalb, IL 60115, USA.
| | - Can Meng
- Public Health Program, Northern Illinois University, DeKalb, IL 60115, USA.
| | - Ansariadi
- Faculty of Public Health, Universitas Hasanuddin, Makassar, South Sulawesi 90245, Indonesia.
| | - Ruslan La Ane
- Faculty of Public Health, Universitas Hasanuddin, Makassar, South Sulawesi 90245, Indonesia.
| | - Syamsuar Manyullei
- Faculty of Public Health, Universitas Hasanuddin, Makassar, South Sulawesi 90245, Indonesia.
| | - Alimin Maidin
- Faculty of Public Health, Universitas Hasanuddin, Makassar, South Sulawesi 90245, Indonesia.
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Ginsburg AS, Gerth-Guyette E, Mollis B, Gardner M, Chham S. Oxygen and pulse oximetry in childhood pneumonia: surveys of clinicians and student clinicians in Cambodia. Trop Med Int Health 2014; 19:537-44. [PMID: 24628874 DOI: 10.1111/tmi.12291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To better understand the availability of oxygen and pulse oximetry, barriers to use, clinician perceptions and practices regarding their role in the management of childhood pneumonia, and the formal education and training regarding these technologies received by student clinicians in Cambodia. METHODS In the clinician survey, we surveyed 81 clinicians practising at all national paediatric, provincial and district referral hospitals throughout Cambodia. Respondents were primarily physicians whose scope of practice included paediatrics, and most reported the presence of oxygen (93% (95% confidence interval (CI) [87, 98])) but less availability of pulse oximetry (51% (95% CI [39, 61])). RESULTS Common barriers to use included a lack of policies and guidelines, as well as a lack of training. In the student clinician survey, 332 graduating medical and nursing students were surveyed, and most reported learning about oxygen (96% (95% CI [94, 98])) and pulse oximetry (72% (95% CI [67, 77])) during their training. CONCLUSIONS Data from both surveys indicate that despite their utility, oxygen and pulse oximetry may be underused in Cambodia. The reported barriers and perceptions of the tools indicate a clear role for improved training for clinicians and students on the use of oxygen and pulse oximetry, the value of oxygen and pulse oximetry for managing childhood pneumonia, and the need for improved policies and guidelines governing their use.
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Wang XF, Liu JP, Shen KL, Ma R, Cui ZZ, Deng L, Shang YX, Zhao DY, Wang LB, Wan LY, Sun YQ, Li YN, Jiang ZY, Xu H, Li XM, Wu ZQ, Liu ZL, Hu YH, Huang Y, He CH, Zhang H, Jiang YH, Liu H, Wang Z. A cross-sectional study of the clinical characteristics of hospitalized children with community-acquired pneumonia in eight eastern cities in China. BMC Complement Altern Med 2013; 13:367. [PMID: 24364897 PMCID: PMC3880031 DOI: 10.1186/1472-6882-13-367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/16/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Community-acquired pneumonia in children is common in China. To understand current clinical characteristics and practice, we conducted a cross-sectional study to analyze quality of care on childhood pneumonia in eight eastern cities in China. METHODS Consecutive hospital records between January 1, 2010 and December 31, 2010 were collected from 13 traditional Chinese medicine (TCM) and western medicine (WM) hospitals in February, May, August, and November (25 cases per season, 100 cases over the year), respectively. A predesigned case report form was used to extract data from the hospital medical records. RESULTS A total of 1298 cases were collected and analyzed. Symptoms and signs upon admission at TCM and WM hospitals were cough (99.3% vs. 98.6%), rales (84.8% vs. 75.0%), phlegm (83.3% vs. 49.1%), and fever (74.9% vs. 84.0%) in frequency. Patients admitted to WM hospitals had symptoms and signs for a longer period prior to admission than patients admitted to TCM hospitals. Testing to identify etiologic agents was performed in 1140 cases (88.4%). Intravenous antibiotics were administered in 99.3% (595/598) of cases in TCM hospitals and in 98.6% (699/700) of cases in WM hospitals. Besides, Chinese herbal extract injection was used more frequently in TCM hospitals (491 cases, 82.1%) than in WM hospitals (212 cases, 30.3%) (p < 0.01). At discharge, 818 cases (63.0%) were clinically cured, with a significant difference between the cure rates in TCM (87.6%) and WM hospitals (42.0%) (OR = 9.8, 95% confidence interval (CI): 7.3 ~ 12.9, p < 0.01). Pathogen and previous medical history were more likely associated with the disappearance of rales (OR = 7.2, 95% CI: 4.8 ~ 10.9). Adverse effects were not reported from the medical records. CONCLUSIONS Intravenous use of antibiotics is highly prevalent in children with community-acquired pneumonia regardless of aetiology. There was difference between TCM and WM hospitals with regard to symptom profile and the use of antibiotics. Intravenous use of herbal injection was higher in TCM hospitals than in WM hospitals. Most of the cases were diagnosed based on clinical signs and symptoms without sufficient confirmation of aetiology. Audit of current practice is urgently needed to improve care.
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Affiliation(s)
- Xue-Feng Wang
- Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Huanggu District, Shenyang, Liaoning 110032, China
| | - Jian-Ping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Beisanhuan Dong Road, Chaoyang District, Beijing 100029, China
| | - Kun-Ling Shen
- Department of Respiratory Medicine, Beijing Children’s Hospital, 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Rong Ma
- First Teaching Hospital of Tianjin University of TCM, 314 Anshan Xi Road, Nankai District, Tianjin 300193, China
| | - Zhen-Ze Cui
- Department of Respiratory Medicine, Dalian Children’s Hospital, 154 Zhongshan Road, Xigang District, Dalian, Liaoning 116012, China
| | - Li Deng
- Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, 318 Renminzhong Road, Yuexiu District, Guangzhou, Guangdong 510623, China
| | - Yun-Xiao Shang
- Department of Pediatric Respiratory Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - De-Yu Zhao
- Department of Pediatric Respiratory Medicine, Nanjing Children’ Hospital, 72 Guangzhou Road, Nanjing, Jiangsu 210008, China
| | - Li-Bo Wang
- Department of Pediatric Respiratory Medicine, Children’s Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China
| | - Li-Ya Wan
- Department of Pediatric Respiratory Medicine, Tianjin Children’s Hospital, 225 Machang Road, Hexi District, Tianjin 300074, China
| | - Yi-Qiu Sun
- Department of Pediatrics, Jiangsu Provincial Hospital of TCM, 155 Hanzhong Road, Nanjing, Jiangsu 210029, China
| | - Yan-Ning Li
- Department of Pediatrics, Affiliated Hospital of Shandong University of TCM, 42 Wenhua Xi Road, Jinan, Shandong 250011, China
| | - Zhi-Yan Jiang
- Department of Pediatrics, Longhua Hospital of Shanghai University of TCM, 725 South Wanping Road, Shanghai 200032, China
| | - Hua Xu
- Department of Pediatrics, Affiliated Hospital of Guangzhou University of TCM, 16 Baiyun Jichang Road, Guangzhou, Guangdong 510405, China
| | - Xin-Min Li
- First Teaching Hospital of Tianjin University of TCM, 314 Anshan Xi Road, Nankai District, Tianjin 300193, China
| | - Zhen-Qi Wu
- Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Huanggu District, Shenyang, Liaoning 110032, China
| | - Zhao-Lan Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Beisanhuan Dong Road, Chaoyang District, Beijing 100029, China
| | - Ying-Hui Hu
- Department of Respiratory Medicine, Beijing Children’s Hospital, 56 Nanlishi Road, Xicheng District, Beijing 100045, China
| | - Yan Huang
- Department of Respiratory Medicine, Dalian Children’s Hospital, 154 Zhongshan Road, Xigang District, Dalian, Liaoning 116012, China
| | - Chun-Hui He
- Department of Respiratory Medicine, Guangzhou Women and Children’s Medical Center, 318 Renminzhong Road, Yuexiu District, Guangzhou, Guangdong 510623, China
| | - Han Zhang
- Department of Pediatric Respiratory Medicine, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, Liaoning 110004, China
| | - Yong-Hong Jiang
- Department of Pediatrics, Longhua Hospital of Shanghai University of TCM, 725 South Wanping Road, Shanghai 200032, China
| | - Hua Liu
- Department of Pediatrics, Affiliated Hospital of Guangzhou University of TCM, 16 Baiyun Jichang Road, Guangzhou, Guangdong 510405, China
| | - Zi Wang
- Department of Pediatrics, Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, 33 Beiling Street, Huanggu District, Shenyang, Liaoning 110032, China
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Abstract
OBJECTIVE To describe the spectrum of clinical features and management of community acquired pneumonia in the UK. DESIGN Prospectively recorded clinical details for all children with possible pneumonia and chest x ray (CXR) changes in 13 hospitals in the North of England between 2001 and 2002. RESULTS 89% of 711 children presenting to hospital with pneumonia were admitted; 96% received antibiotics, 70% intravenously. 20% had lobar CXR changes, 3% empyema and 4% required intensive care. Respiratory rate (RR), hypoxia and dyspnoea all correlated with each other and prompted appropriate interventions. Admission in children, not infants, was independently associated with RR, oxygen saturation, lobar CXR changes and pyrexia. Neither C-reactive protein, lobar CXR changes or pyrexia were associated with severity. Children over 1 year old with perihilar CXR changes more often had severe disease (p = 0.001). Initial intravenous antibiotics were associated with lobar CXR changes in infants and children and with dyspnoea, pyrexia and pleural effusion in children. The presence of pleural effusion increased duration of antibiotic treatment (p<0.001). Cefuroxime was the most often used intravenous antibiotic in 61%. Oral antibiotics included a penicillin in 258 (46%), a macrolide in 192 (34%) and a cephalosporin in 117 (21%). Infants stayed significantly longer (p<0.001) as did children with severe disease (p<0.01), effusions (p = 0.005) or lobar CXR changes (p< or =0.001). CONCLUSIONS There is a high rate of intravenous antibiotic administration in hospital admissions for pneumonia. Despite lobar CXR changes not being independently associated with severe disease, initial lobar CXR changes and clinical assessment in children independently influenced management decisions, including admission and route of antibiotics.
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Affiliation(s)
- Julia E Clark
- Department of Paediatric Infectious Disease, Newcastle General Hospital, Newcastle, UK.
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